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dc.contributor.authorKerrigan, Vickien
dc.contributor.authorKelly, Angelaen
dc.contributor.authorLee, Anne Marieen
dc.contributor.authorMungatopi, Valerinaen
dc.contributor.authorMitchell, Alice Gen
dc.contributor.authorWyber, Rosemaryen
dc.contributor.authorRalph, Anna Pen
dc.identifier.citation© 2021. The Author(s).en
dc.identifier.citationBMC Health Serv Res. 2021 Oct 20;21(1):1127. doi: 10.1186/s12913-021-07159-9.en
dc.description.abstractBACKGROUND: In Australia's north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants. METHODS: This is a two-year, outreach-to-household, pragmatic intervention implemented by Aboriginal Community Workers in three remote communities. The qualitative component was shaped by Participatory Action Research. Yarning sessions and semi-structured interviews were conducted with 14 individuals affected by, or working with, ARF/RHD. 31 project field reports were collated. We conducted a hybrid inductive-deductive thematic analysis guided by critical theory. RESULTS: Aboriginal Community Workers were best placed to support two of the six domains: housing and environmental health support and health navigation. This was due to trusting relationships between ACWs and families and the authority attributed to ACWs through the project. ACWs improved health literacy and supported awareness and empowerment; but this was limited by disease complexities. Consequently, ACWs requested more training to address knowledge gaps and improve knowledge transfer to families. ACWs did not have skills to provide health professionals with education or ensure health and education services participated in ARF/RHD. Where knowledge gain among participant family members was apparent, motivation or structural capability to implement behaviour change was lacking in some domains, even though the model was intended to support structural changes through care navigation and housing fixes. CONCLUSIONS: This is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable individual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.en
dc.subjectHealth Educationen
dc.subjectOceanic Ancestry Groupen
dc.subject*Rheumatic Fever/epidemiology/prevention & controlen
dc.subject*Rheumatic Heart Disease/epidemiology/prevention & controlen
dc.titleA community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia.en
dc.typeJournal Articleen
dc.identifier.journaltitleBMC health services researchen
dc.description.affiliationMenzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, 0811, Australia.
dc.description.affiliationMenzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, 0811, Australia.en
dc.description.affiliationGeorge Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales, 2042, Australia.en
dc.description.affiliationTelethon Kids Institute, 15 Hospital Avenue, Nedlands, Western Australia, 6009, Australia.en
dc.description.affiliationRoyal Darwin Hospital, Darwin, Northern Territory, 0811, Australia.en
local.issue.number1472-6963 (Electronic)-
local.issue.number1472-6963 (Linking)-
Appears in Collections:(a) NT Health Research Collection

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